The nurse is preparing to administer medications for an eight-month-old infant with heart failure. The infant has a blood pressure of 114/66 mm Hg, apical pulse of 88 beats/minute, and respirations of 30 breaths/minute.
Which medication should the nurse withhold until the healthcare provider is notified?
Digoxin.
Furosemide.
Hydralazine.
Enalapril.
The Correct Answer is A
For an eight-month-old infant with heart failure, the nurse should withhold digoxin if the infant's apical pulse is less than 90 beats/minute and notify the healthcare provider. In this case, the infant's apical pulse is 88 beats/minute, so the nurse should withhold the digoxin and notify the healthcare provider.
Furosemide ( B), hydralazine (C), and enalapril (D) do not have specific parameters for withholding based on the infant's vital signs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
When using an ophthalmic anti-infective ointment, it is important to prepare the child for blurry vision after ointment application. This is because the ointment can temporarily blur vision after application. It is important to follow the instructions on the medication label and continue using the ointment for the full course of treatment, even if symptoms improve before then ¹.
Correct Answer is C
Explanation
Acute rheumatic fever is a serious inflammatory condition that can develop after a streptococcal infection, particularly if the infection is not treated or resolved properly. The most common initial symptom of acute rheumatic fever is a sore throat, which is usually accompanied by a fever and swollen lymph nodes.
While mumps, chickenpox, and influenza are all infectious diseases, they are not directly linked to the development of acute rheumatic fever. However, a recent or untreated streptococcal infection (such as strep throat) can lead to the development of acute rheumatic fever.
Therefore, when obtaining a health history from a child with a diagnosis of acute rheumatic fever, it is most significant to inquire about recent or untreated sore throat, as this is the most likely cause of the condition.
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